无法切除局限于肝内的肝细胞肝癌HT临床疗效观察

Hypofraction radiotherapy by helical tomotherapy for unresectable but confined intrahepatic hepatoeellular carcinoma is efficient and safe in comparison with conventional 3-dimension conformalradiotherapy

目的 观察HT对局限于肝内的肝细胞肝癌的安全性,并与3DCRT疗效比较。方法2011年6月对35例未手术切除的局限于肝内且无远处转移和癌栓的肝细胞肝癌患者接受HT大分割治疗,单次剂量从2.4 Gy递增至5.0 Gy,单次中位剂量为3.2 Gy,中位剂量50.0 Gy;同期45例接受3DCRT常规分割放疗患者,中位剂量54.0 Gy。比较两组患者的不良反应、临床疗效和生存期。Kaplan-Meier法计算生存率并Logran法检验,Cox模型多因素预后分析。结果 两组不良反应相近（要为消化道反应、肝功能损害和血液系统毒性,P=0.293~0.664）。HT和3DCRT的OR率分别为60%和33%（P=0.024）,DC率分别为94%和89%（P=0.459）,1、2、3年OS率分别为97%和80%（P=0.025）、81%和55%（P=0.008）、67%和50%（P=0.043）。多因素分析发现肿瘤〈8 cm （P=0.005）、放疗前行动脉栓塞化疗（P=0.000）及接受HT （P=0.002）者将在生存中获益。结论 无法切除局限于肝内的肝细胞肝癌患者HT显示精确治疗优势,在不增加不良反应同时大分割放疗缩短放疗时间,延长患者生存期。

Objective To evaluate the safety of helical tomotherapy （HT） for hepatocellular carcinoma confined to the liver, and to investigate the efficacy of HT by comparison with three-dimensional conformal radiotherapy （3DCRT）. Methods In June 2011, hypofractionated HT was performed in 35 patients with unresectable hepatocellular carcinoma confined to the liver who had no distant metastasis or tumor thrombosis. The dose in each fraction increased from 2.4 Gy to 5.0 Gy with a median dose of 3.2 Gy. The median dose for the total treatment was 50.0 Gy. Within the same period, 45 patients received conventionally fractionated 3DCRT with a median dose of 54.0 Gy. The adverse reactions, clinical outcomes, and survival time were compared between the two groups. The survival rate was calculated with Kaplan-Meier method,and log-rank test was used to estimate statistical significance of survival differences. Multivariate analysis of survival was carried out with Cox’s regression model. Results There were no significant differences in adverse reactions between the two groups. TheObjective response rate was significantly higher in the HT group than in the 3DCRT group （60% vs. 33%, P=0.024）. There was no significant difference in the disease control rate between the two groups （94% vs. 89%, P=0.459）. The HT group showed significantly higher 1-, 2-, and 3-year overall survival rates than the 3DCRT group （97% vs. 80%, P=0.025;81% vs. 55%, P=0.008;67% vs. 50%, P=0.048）. The multivariate analysis indicated that tumor smaller than 8 cm, transarterial chemoembolization before radiotherapy, and HT were associated with improved survival （P=0.005;P=0.000;P=0.002）. Conclusions HT shows an advantage in precise treatment of hepatocellular carcinoma confined to the liver. With acceptable toxicity, hypofractionated HT shortens the treatment duration and improves the survival in patients.